As Nigeria marks yet another World AIDS Day, an expanded collaboration between public, private health facilities and traditional birth attendants (TBAs) maybe one of the ways to reduce the increasing number of Mother To Child Transmission of HIV, given the declining numbers of access to antenatal care (ANC) and hospital-based delivery. REGINA OTOKPA reports
“Not every pregnant woman in this community can afford between N200 to N300 as bike fare to Asokoro General Hospital. We have women and chemists who offer antenatal care services as majority of us give birth there when we are in labour,” Mrs Joe Frina has said.
Frina is a resident of Kpaduma community, a rural enclave in the middle of Asokoro where a high percentage of pregnant women are found not to attend pre or post natal care for various reasons ranging from poverty, total absence of healthcare facility, poor attitude of some health care workers and long stay hours at hospitals. “Asking me to attend Ante-Natal care in public hospitals is one of the worst punishments ever; you must leave the house very early because of the crowd; and some nurses are just mean. The mix of different odours can resurrect a dead rat,” Atama Rabi, a resident of Byazhin in Kubwa, also lamented.
Frina and Rabi live in different communities thousands of kilometres apart but have one thing in common; they do not know their HIV status. Mothers to five and eight children respectively, it would be a double jeopardy if they happen to be HIV positive and have ignorantly transmitted same to their children all because they failed to attend antenatal care and deliver in health facilities.
Sadly, a good number of pregnant women like Frina and Rabi who prefer the use of skilled or unskilled Traditional Birth Attendants (TBAs), maybe exposing their children to HIV infections, resulting from failure to uptake ANC services. A Public Health Consultant, Dr. Isah Umoru who noted that the use of TBAs even in Abuja was more prominent in the rural areas, quoted statistics from the United Nations Population Fund (UNFPA) which revealed that about 60 per cent of pregnant women prefer to deliver at home rather than health facilities where they can access professional help. As a result, about 63 per cent of HIV positive women do not have access to Prevention of Mother To Child Transmission (PMTCT) services, which are usually provided at health facilities for expectant mothers diagnosed to be HIV positive.
This explains the data from the National Demographic Health Survey (NDHS) 2018 which shows that while baby delivery from two per cent of pregnant women takes place elsewhere, only 39 per cent delivery occur in health facilities. Throwing more light on the issue at hand, ana Assistant Director, National AIDs & STIs Control Programme (NASCP), Federal Ministry of Health (FMoH), Dr. Olugbenga Ijaodola said the percentages can not be disassociated from the high patronage of TBA’s by majority of pregnant women, who have lost confidence in the formal public health sector, and those unable to afford care due to financial constraints.
He said: “Nigeria contributes 22,000 new HIV infections among children. three in four pregnant women in Nigeria are not captured at ANC, two third of expected pregnancies are not captured in the PMTCT reporting system. However, over 90 per cent of pregnant women who do not show up at health facilities reporting PMTCT get tested for HIV. Only 28 per cent of HIV exposed infants had access to early infant diagnosed in 2020.” However, what is more worrisome is having a good number of pregnant women who tested negative to HIV in their first and second trimester, getting retested and found to be positive with HIV at the time of birth.
For instance, out of 2,504,478 pregnant women 2,496,679 women tested negative however, out of 41,509 pregnant women who were retested, 149 were found to be positive to the virus. In order to cut down the number of MTCT of HIV, Ijaodola who doubles as the National PMTCT lead, said it has become necessary to remove barriers hindering pregnant women from accessing PMTCT services, in order to ensure positive babies are identified on time and immediately placed on treatment.
Speaking during a media dialogue organised by the United Nations Children’s Fund (UNICEF) in collaboration with Journalists Alliance for the Prevention of Mother-To- Child Transmission of HIV/AIDS (JAPIN) in Calabar, Cross River State recently, he advocated the use of TBA’s by public and private health facilities to bridge the existing gap of ANC services in the country. Already, engagements have begun with some of the TBAs to ensure they help improve PMTCT services by educating and ensuring their clients get tested for HIV and to follow up on HIV positive expectant mother’s to enroll and sustain treatment to ensure better health outcomes.
“We have started that process across board with our state counterparts to see how they can engage with the community structures especially the TBAs “Based on their frameworks, some states have been able to carry out their mapping, some have been engaging for years. Others are just starting but we believe that with this across board it’s going to be a good game for us.
If we continue to be guided by the framework, we will be able to get across and increase engagement. “Irrespective of what challenges we are facing in our healthcare system, we must ensure we have access to every pregnant woman and we are able to test them all for HIV/AIDS and those found positive we must be able to link them up and place them on treatment, encourage them to deliver in their facilities so we can have access to their babies in Infant diagnosis services. “If we collectively agree to do this, very soon we will change the narrative for MTCT in Nigeria and we can start talking about elimination of MTCT in Nigeria.
Every pregnant woman must not be left behind in terms of testing and for everyone found to be positive it is the beginning of life. “We have noticed that our coverage is going up but we still have a lot of women to reach especially now that we discovered that a lot of our women don’t come to the health care facilities. We believe the economic situation is contributing to this among others we also know that probably the state of health care facilities are not encouraging but all these are changing now with the new drive that is coming under the primary health care under one roof drive.
“The BHCPF is helping us to see how we can improve on our health care services. Outside that we still believe that the health seeking behaviour of Nigerians needs to improve. Even where there are availability of services people don’t want to still patronise the hospital. So all these have to change with the right information.” Worried over the difficulty of retaining women identified to be living with HIV on treatment, the PMTCT team lead said there was need to identify the root causes affecting sustained treatment. “One of the key things we want to do with this is see how we can improve drug availability at various levels. That is why we want to have where we can link women to treatment. These will be places that are not too far from them to clear off the cost burden of moving from one place to the other.
“We also talked about the multi drug prescription where we can give someone a drug for three months once the woman is termed responsible, to reduce the number of hospital visits and reduce the economic pressure on them also. The country must work towards eliminating user fees for pregnant women by strengthening the National Health Insurance Scheme (NHIS) as well as State Health Insurance Schemes (SHIS) to include PMTCT/Reproductive Maternal Newborn Child Adolescent Health plus Nutrition (RMNCAH) into the benefit package, using the Basic Health Care Provision Fund (BHCPF).
“Another key intervention critical in PMTCT, is the maternal testing strategy made easy through the Rapid Test Kits (RTK) for HIV testing. This involves periodic testing of HIV negative women during the period of breastfeeding. What ever effort we have put in line is supposed to be led fully by the state because we believe that it is at that level we can make maximum impact. “We want consistency in what we do and that is why we brought out the framework for a year and half which we intend to be monitoring quarterly for each state. The states develop the frameworks.
We support them through proper monitoring so that by December 2022, we can know where we are in terms of MTCT “No pregnant woman should be left without being tested for HIV AIDS. No HIV positive pregnant woman should be left behind, children born positive with HIV should be provided with services or linked to treatment.”